Nurse Auditor

Become a part of our caring community and help us put health first The Nurse Auditor 2 will reputed company acute inpatient Short Stay Reviews/clinical audits considering reputed company medical factors and MCG, to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 is a work from home position who will reputed company Short Stay Reviews/clinical audits to ensure that medical record documentation and diagnosis coding/DRG for services rendered is complete, compliant and accurate to support optimal reimbursement. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical experience to conduct short stay reviews of provider services and billing. Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to reputed company an impact WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. WORK HOURS: Typical business hours are Monday-Friday on EST (Eastern Standard Time), regardless of the associate's home time zone. 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs.

Required Qualifications

• Active Registered Nurse (RN) license or Licensed Practical Nurse/Licensed Vocational Nurse (LPN or LVN), in your state of residence
• Minimum of 5 years acute inpatient bedside and claims auditing experience
• Minimum of 3 years' experience utilizing MCG guidelines
• Demonstrated ability to reputed company process/project initiative
• MS Office proficiency
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Demonstrated ability to consider reputed company medical factors
• Ability to work independently and manage workload
• Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
• Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Associate or Bachelor’s Degree
• Inpatient nursing experience, ideally including discharge planning, hospital case management background
• Prospective payment methodologies, auditing experience
• Clinical documentation improvement (CDI) knowledge

Additional Information Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested
• Satellite, cellular and microwave reputed company can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• reputed company will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information

Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology reputed company Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move reputed company from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-03-2025 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Apply tot his job Apply To this Job